High neutrophil and basophil blood counts are associated with increased factor II plasma coagulant activity and may be predictors of mortality in patients with stable coronary artery disease.

Abstract

Background: white blood cell (WBC) count is widely available in clinical practice and has been proposed to provide prognostic information in coronary artery disease (CAD), with elevated levels of WBC predicting adverse cardiovascular outcomes. Recently, neutrophil extracellular traps (NETs) have been demonstrated to be a scaffold and stimulus for thrombus formation.\ud
Aims: to investigate i) the correlation between WBC counts and factor II plasma coagulant activity (FII:c), and ii) WBC prognostic significance in the setting of secondary prevention of CAD.\ud
Methods: WBC count and FII:c were analyzed in 750 subjects (554 CAD and 196 CAD-free, 77.6% males, mean age 60.0±10.5 years) not taking anticoagulant drugs within the angiographically-controlled Verona Heart Study. Moreover, WBC count was assessed as predictor of total and cardiovascular mortality in 823 stable CAD patients (80.2% males, mean age 61.8±9.7 years). Subjects with overt leukocytosis (>10,000/L) or leukopenia (<4,000/L) were excluded. \ud
Results: Neutrophils (=0.085; P=0.021) and basophils (=0.073; P=0.042) were significant predictor of FII:c variability in a linear regression model adjusted for all blood cell counts, age, sex, hs-CRP, and CAD diagnosis. In the longitudinal study, after a median follow-up of 61 months, 160 (19.4%) subjects died, 107 (13%) of whom for cardiovascular causes. High levels of neutrophils, monocytes, eosinophils, and basophils were associated with an increased mortality rate in the CAD population. However, in multi-adjusted Cox regression models only neutrophils and basophils remained predictors of total (the highest versus the lowest quartile HRs: 2.87 (1.54-5.34) and 1.71 (1.06-2.75), respectively) and cardiovascular mortality (HRs: 3.31 (1.42-7.71) and 1.85 (1.02-3.35), respectively). \ud
Conclusions: high neutrophil and basophil blood counts are associated with an enhanced FII:c and may be independent predictors of total and cardiovascular mortality in patients with stable CAD